In:
Pediatrics, American Academy of Pediatrics (AAP), Vol. 153, No. 2 ( 2024-01-01)
Abstract:
Patient and Family Centered I-PASS (PFC I-PASS) emphasizes family and nurse engagement, health literacy, and structured communication on family-centered rounds organized around the I-PASS framework (Illness severity-Patient summary-Action items-Situational awareness-Synthesis by receiver). We assessed adherence, safety, and experience after implementing PFC I-PASS using a novel “Mentor-Trio” implementation approach with multidisciplinary parent-nurse-physician teams coaching sites. METHODS Hybrid Type II effectiveness-implementation study from 2/29/19-3/13/22 with ≥3 months of baseline and 12 months of postimplementation data collection/site across 21 US community and tertiary pediatric teaching hospitals. We conducted rounds observations and surveyed nurses, physicians, and Arabic/Chinese/English/Spanish-speaking patients/parents. RESULTS We conducted 4557 rounds observations and received 2285 patient/family, 1240 resident, 819 nurse, and 378 attending surveys. Adherence to all I-PASS components, bedside rounding, written rounds summaries, family and nurse engagement, and plain language improved post-implementation (13.0%–60.8% absolute increase by item), all P & lt; .05. Except for written summary, improvements sustained 12 months post-implementation. Resident-reported harms/1000-resident-days were unchanged overall but decreased in larger hospitals (116.9 to 86.3 to 72.3 pre versus early- versus late-implementation, P = .006), hospitals with greater nurse engagement on rounds (110.6 to 73.3 to 65.3, P & lt; .001), and greater adherence to I-PASS structure (95.3 to 73.6 to 72.3, P & lt; .05). Twelve of 12 measures of staff safety climate improved (eg, “excellent”/“very good” safety grade improved from 80.4% to 86.3% to 88.0%), all P & lt; .05. Patient/family experience and teaching were unchanged. CONCLUSIONS Hospitals successfully used Mentor-Trios to implement PFC I-PASS. Family/nurse engagement, safety climate, and harms improved in larger hospitals and hospitals with better nurse engagement and intervention adherence. Patient/family experience and teaching were not affected.
Type of Medium:
Online Resource
ISSN:
0031-4005
,
1098-4275
DOI:
10.1542/peds.2023-062666
Language:
English
Publisher:
American Academy of Pediatrics (AAP)
Publication Date:
2024
detail.hit.zdb_id:
1477004-0
detail.hit.zdb_id:
207677-9
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